Dr Matthew Fisher
The main public health challenges of our time lie with human psychology, where increasing rates of distress and mental ill-health intersect with other social problems such as family violence, substance abuse, and social division.
Despite strong evidence on social determinants of mental health mediated by psychosocial stress, governments continue to pour billions into individualised medical responses.
The rapidly escalating use of antidepressants and ADHD medications has not reduced the scale of mental health problems in Australia and similar countries.
The problems are seemingly getting worse – especially among young people.
In effect, we are trying to medicate our way out of what are predominantly social problems.
While mental healthcare is necessary for people with severe or chronic illness, public health advocates must lead calls for decisive change in emphasis and direction, toward a public health approach to psychological wellbeing.
The essential elements of this change are to move from:
- A disease/treatment to a psychosocial/determinants view of the problem
- A remedial treatment focus to primary prevention and wellbeing promotion
- Mental health services to policy focused on socioeconomic environments
I argue for this comprehensive public health approach to wellbeing in my recently published book, How to Create Societies for Human Wellbeing: Through Public Policy and Social Change.
I start with first principles, exploring a public health understanding of what wellbeing is, how it ‘works’ in the brain and body, and how it is shaped by social, economic and environmental conditions. I describe how contemporary societies undermine wellbeing, and then set out a framework of political principles, policies, and practices to promote psychological wellbeing.
To understand psychological wellbeing in a public health way, it is essential to start with stress.
Stress arousal has a positive role to play in social cognition and behaviour, but it can shift into a pattern of harmful chronic stress under certain conditions.
Psychological wellbeing relates to, in part, our ability to self-regulate social behaviour to cope effectively with minor stressors, engage in activities which reduce stress, and ultimately avoid chronic stress.
With this foundation, it becomes clearer how and why social conditions can cause chronic stress, contributing to fatigue, psychological distress, anxiety, depression or substance abuse problems, and harmful social behaviours.
People under chronic stress are more likely to turn to addictive behaviours such as alcohol abuse as a form of relief seeking.
Through this lens, we also understand the essential social conditions needed for psychological wellbeing over the life-course.
These conditions include positive family environments for early child development, access to meaningful work, social connectedness, contact with nature, secure housing, healthy neighbourhoods, culture and creativity, education for lifelong learning, and comprehensive primary health care.
Governments must consider public policy for wellbeing and take action to promote equitable access to this range of conditions. The currently entrenched mode of social policy, to fund privatised social services, is not going to cut it.
Instead, universal access to wellbeing conditions requires another shift in social policy methods, away from top-down methods of contracting service providers, toward a place-based approach, where government works with communities to decide and implement localised wellbeing strategies to meet local needs.
Such strategies could usefully focus on any of the conditions noted above and may well extend into others over time.
There are signs of positive change in the Australian policy environment moving toward a public health approach to wellbeing.
For example, Work Health and Safety legislation now requires larger employers to consider ‘psychosocial hazards’ (i.e. stressors) in their workplaces and take steps to reduce them.
The national Treasury has established the ‘Measuring What Matters’ Framework to monitor a comprehensive range of social and environmental indicators seen as relevant to wellbeing.
However, policy failures from governments to meaningfully address systemic sources of psychosocial stress – such as socioeconomic inequities and poverty, discrimination, excessive work hours, insecure work, housing stress, harmful effects of social media, and climate change – mean we have a long way to go.
How to Create Societies for Human Wellbeing: Through Public Policy and Social Change is available now through Policy Press and other popular book outlets. You can request a free inspection copy here.
Dr Matthew Fisher is a Senior Research Fellow at the University of Adelaide.
Image: Jonny Cohen / Unsplash
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